A PC治疗前后食管黏膜COX-2的基因表达及意义

摘要

Objective To research expression changes of COX-2 gene in Barrett′s esophageal mucosa before and after argon plasma coagulation (APC)operation and to explore it′s clinical curative effect and possible mechanism .Methods 66 barrett′s e-sophageal diagnosed with gastroscope and pathology were randomly divided into normal esophageal group (the negative control group ,group A) ,the APC with acid suppression therapy group(group B) ,Acid antimicrobial drug treatment group(group C) .Ob-serve symptom relief condition ,barrett esophagus epithelium ablation under gastroscope before and after treatment ,esophageal mu-cosa tissue samples was detected by real-time fluorescent quantitative PCR technique .Expression of COX-2 gene in barrett′s esoph-ageal mucosa were compared among groups .Results Compared with group A ,both Group B and group C could effectively relieve symptoms (P<0 .05) .Symptom remission rate had no no statistically significant difference in Group B and group C .Barrett esopha-gus epithelium was not significantly narrowed under gastroscope follow-up Group A and group C ,while Barrett esophageal mucosal occurred ablation with pink mucous covered in Group B .The expression of Cox-2 mRNA in group B decreased ,which was similar to group A .The expression of Cox-2 mRNA in group C also decrease ,but there was no significant differences before and after treat-ment .Conclusion APC with acid suppression therapy could effectively relieve symptoms ,melting Barrett esophagus epithelium ,and is of a safe and effective treatment on Barrett′s esophagus .%目的：研究Barrett食管病例氩离子凝固术（APC）联合药物治疗及单纯药物治疗前、后食管黏膜中环氧化酶-2（COX-2）的基因表达变化。判断Battett食管治疗的临床疗效及可能机制。方法经胃镜及病理诊断的Barrett食管66例，分为3组，A组为阳性对照组（不治疗组），B组为A PC联合抑酸剂治疗组，C组为抑酸剂药物治疗组。治疗前、后观察患者症状缓解状况，胃镜下Barrett食管上皮消融情况，取食管黏膜组织标本，采用实时荧光定量聚合酶联反应（PCR）技术检测，Barrett食管黏膜及对照组食管黏膜中COX-2 mRNA表达情况，进行组间及治疗前、后比较。结果 B组、C组均可有效地缓解症状，与A组相比差异有统计学意义，B、C组症状缓解率相比差异无统计学意义。A组与C组随访胃镜下Barrett食管上皮未见明显缩小，而B组Barrett食管黏膜消融，代之以淡红色食管黏膜覆盖。胃镜联合药物治疗后COX-2 mRNA的表达明显降低至正常食管水平，而C组COX-2 mRNA的表达降低，但与治疗前对比差异无统计学意义。结论单纯抑酸治疗与APC联合抑酸剂治疗相比，作用差， APC联合抑酸剂治疗后可以有效地缓解症状，消融Barrett食管上皮，是治疗Barrett食管的一种安全、有效的方法。